Should Omphaloceles be Re-classified?

Background: Omphaloceles are presently classified into 'minor' and 'major' categories depending on the diameter of the umbilical defect. In developed countries most 'major' cases are treated with silo, parenteral nutrition and progressive compression. In developing countries most cases are managed conservatively with honey dressing. This may take 1-2 months for proper eschar to form. Even when successful, most patients don't come for secondary repair. The objective of this review was to re-classify omphaloceles into 'minor', 'intermediate' and 'major' anomalies.
Methods: Cases of omphaloceles treated from 2002-2007 were retrospectively reviewed. Patients whose diameter of defects were more than 5cm, but closed primarily were separated and analyzed.
Results: Forty four (44) patients with anterior abdominal wall defects were seen during the study period. There were 37 cases of omphalocele, 4 bladder extrophy and 3 gastroschisis. Of the 37 omphaloceles, 12 were 'minor' and 25 'major'. Twelve of the 'major' cases were closed primarily. The mean size of the defect was 7.5 cm by 6.3cm. There were 5 boys and 7 girls. Three of them were operated within 48 hours, but all died. The other 9 were properly resuscitated and operated between 3 and 15 days. Only 2 died.
Conclusion: More than half of cases originally classified as 'major' have plenty of skin and fascia to be closed primarily if properly selected. This classification into a new'intermediate' category helps to isolate this group for primary closure.